Provider Demographics
NPI:1124159504
Name:QUILLEN, LOYD PAUL (OPTICIAN)
Entity type:Individual
Prefix:MR
First Name:LOYD
Middle Name:PAUL
Last Name:QUILLEN
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:421 NORTH MAIN ST
Mailing Address - Street 2:QUILLEN OPTICAL
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22802
Mailing Address - Country:US
Mailing Address - Phone:540-433-2875
Mailing Address - Fax:540-433-2875
Practice Address - Street 1:421 NORTH MAIN ST
Practice Address - Street 2:QUILLEN OPTICAL
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22802
Practice Address - Country:US
Practice Address - Phone:540-433-2875
Practice Address - Fax:540-433-2875
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA1101000503156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1075500001Medicare ID - Type UnspecifiedDURABLE MEDICAL EQUIP